Epilepsy is defined as a chronic neurological condition characterized by recurrent, unprovoked seizures. It is one of the most common serious neurological disorders in the United States and often requires long-term management. Each year 150000 people in the United States are newly diagnosed as having epilepsy, with the cumulative lifetime incidence approaching 3%. The incidence is highest during the first year of life and in elderly persons. Although most people with epilepsy become seizure-free with appropriate therapy, 30% to 40% of patients will continue to have seizures despite the use of antiepileptic drugs either alone or in combination.
Patients with uncontrolled seizures experience significant morbidity and mortality and face social stigma and discrimination as well. In the United States, only 17% of patients with new-onset epilepsy are initially seen by a neurologist. Furthermore, primary care physicians provide approximately 40% of the long-term management of epilepsy patients with or without initial consultation with a specialist.
Unfortunately, a survey of general practitioners revealed that only 40% of responders felt confident in their knowledge of epilepsy and two thirds were unfamiliar with the new antiepileptic drugs. A recent survey of 71 patients with epilepsy who are treated exclusively by general practitioners showed that 45% had experienced a seizure within the past year, 68% complained of drowsiness or difficulty in concentration with their current medications, and 28% were prescribed polytherapy.
Prior to 1993, the choice of an anticonvulsant medication was limited to phenobarbital, primidone, phenytoin, carbamazepine, and valproate. Although these “traditional” anticonvulsants have the advantage of familiarity as well as proven efficacy, many patients are left with refractory seizures as well as intolerable adverse effects. Since 1993, new medications have been approved by the US Food and Drug Administration (FDA), expanding treatment options. The newer antiepileptic drugs offer the potential advantages of fewer drug interactions, unique mechanisms of action, and a broader spectrum of activity. With more options, however, comes the challenge of determining what role the new antiepileptic drugs play in optimizing treatment in addition to understanding important adverse effects and drug interactions of these increasingly prescribed medications.
Managing acute pathology of often relies on the addressing underlying pathology and symptoms of the disease. There is currently a need in the art for new compositions to treatment of epilepsy.